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Home My WebLink About03-23-15 NOTICE OF CLAIM COUK'T OF COMMON PLEAS OF CUMRERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DNISION ESTAT� OF DORIS A. ROYER, DECEASED No. 2015-00026 To the Clerk of thc Orphans' CouR Division: Kindly entec the claim of Messiah Lifeways in the amount of$17,732.00 agai�st the above-captioned Estate. The Decedent, who formerly resided at 100 Mt. Allen Drive, Mechanicsburg, Pennsylvania U055, died on October 23, 2014. This claim is a level 3 priority claim under 20 Pa.C.S. §3392(3) for nursing facility services provided within 6 months of the date of death. Wcitten no[ice of said claim was given[o Craig A. Hatch, Esquire, counse] for the Estate of Doris A. Royer on March 20, 2015. Claimanr. Messiah Lifeways 100 Mt. Allen Road Mechanicsburg, PA 170�5 Respectfully Submitted, Latsha Davis & McKenna, P.C. Datc: �� "�� S[even M. Montresor Attorney No. 74244 1700 Bent Creek 13oulcvard, Suite 140 Mechanicsburg, PA 17050 Phone: (717) 620-2424 FaY: (717) 620-2444 smontcesor@Idylaw.com i: c, r- ^� ��J U ' 7 !/ (`� C� ' . G /\\\ )�..!'� U' 1 ` s3aow�i � � MESSIAH � � �. f� �� I. C� ��_ � Lfewa s F��Ped1 w � at MESSIAH VILLAGE 100 MT.ALLEN OR..MECHANICSBl1RG.PA 1]O55 RESIDENT# UNIT STMT. DATE 81321 255 D OS/31/2013 RESIDENT(S) PAUL HOFFMAN THE ESTATE OF DORIS ROYER 6349 BENNINGTON ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $10 016.60 DETACH AND RETURN THIS PORTION W ITH YOUR REMITTANCE $ _ . AMOUNT R�MITT��. DATE DESCRIPTION RATE �� CHARGES CREDITS BALANCE Balance Forward 10,375.60 oel3ona PAYMENT RECEIVED - THANK YOU 10,375.60 0.00 **' Nursing Care"' o6�o�na PREVAIL BRIEF 1.40169.01 236.60 236.80 os/o�na RM/ BRD - NURSING - SEMI-PVT 06I01-O6/ 326.00 30.00 9,780.00 10,076.60 Page 1 , RESIDENT tl WRRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 81321 10,016.60 0.00 0.00 0.00 0.00 $10,016.60 ReSioENi Nnnne THE ESTATE OF DORIS ROYER `°'�'�°, Please make check payable to Messiah Lifeways at Messiah Village. A 7%fnance charge may be assessed on accounts for which payment has not been received by the due date. If you have any ques[lons or concerns about your bill, please address them directly to Fiscal Services at 790-8220. � MESSIAH � � � L. C� I ��. � �,�a,mp� Lfewa s w � at MESSIAH VILLAGE mo M�.nuerv oa.,MECHnwcseuac,an noss RESIDENT# UNIT STMT. DATE 81321 255 D 08/31/2013 RESIDENT S PAUL HOFFMAN THE ESTATE OF DORIS ROYER 6349 BENNINGTON ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $20 870.35 DETACHAND RETURN THIS PORTION WITH YOUR REMITTANCE $ �MOVNT REMITTED DATE DESCRIFTION RATE ��V CHARGES CREDITS BALANCE Balance Forward 10,016.60 "' Nursing Care •" o��o�na PREVAIL BRIEF 1.45195.0( 282.75 10,299.35 a�l0ina RMI BRD - NURSING - SEMI-PVT 07/01-071 341.00 31.00 10,571.00 20,870.35 Pega 1 RESIDENTN CURRENT OVER30 OVER60 OVER90 OVER120 TOTALAMOUNT�UE 81321 10,853.75 10,016.60 0.00 0.00 0.00 $20,870.35 RESi�ENr NnMe THE ESTATE OF DORIS ROYER `°""°�°' Please make check payable to Messiah Lifeways at Messiah Village. A 1%finance charge may be assessed on accounts for which payment has not heen receivad by ihe due date. If you have any questions or concerns about your bill, please address them directly to Fiscal Sarvices at 790-8220. � MESSIAH � � F�. � � I ?�' �% ��.wmP� Lfewa s w � at MESSIAH VILLAGE ioo mt.A�IEN DR.,mECNaNiCSeUaG, an i�ass RESIDENT# UNIT STMT. DATE 81321 255 D 08/31/2073 RESIDENT S PAUL HOFFMAN THE ESTATE OF DORIS ROYER 6349 BENNINGTON ROAD MECHANICSBURG, PA 17050 TOTALAMOUNTDUE $21436.75 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE � __... AMOUNT.R�MITTE� . .____ __._.. . _..._. .. . . _ . .. ._ ____. __.__ .. . .. _. DATE DESCRIPTION RATE �� CHARGES CREDITS BALANCE Balance Forward 20,870.35 oen2na ppYMENT RECEIVED - THANK YOU 10,016.60 70,853.75 '** Nursing Care •"` oa�ovta RMI BRD - NURSING - SEMI-PVT OBI01-O8/ 841.00 31.00 10,571.00 27,424.75 08123114 WOUND CARE LV 2 12.00 7.00 12.00 27,438.75 PaBe i I RESIDENTk CURRENT OVER30 OVER60 OVER90 OVER120 TOTALPMOUNTDUE 87321 10,583.00 10,853.75 0.00 0.00 0.00 $21,436.75 RESiDENr NnMe THE ESTATE OF DORIS ROYER FonnPBOi Please make check payable to Messiah Lifeways al Messiah Village. A 1%tinance charge may be asaessed on accounts for which payment has not been received by the due date. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. �,/, � MESSIAH � L �; t, � ��I �� mp� � ' Lfewa s w Y at MES5IAH VILLAGE ioo r,rr n��eN oa.,MeCHnNicseuRc,an noss RESIDENT# UNIT STMT. DA7E "........ 81327 255 D 08/31/2013 RESIDENT S PAUL HOFFMAN THE ESTATE OF DORIS ROYER 6349 BENNINGTON ROAD MECHANICSBURG, PA 17050 TOTALAMOUNT DUE $21 367.40 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE � _ AMOUNT REMITTED DATE DESCRIPTION RATE Dam� CHARCaES CREDITS BALANCE UNl6 Balance Forward 21,436.75 09116114 PAYMENT RECEIVED - THANK YOU 10,299.35 11,137.40 *** Nursing Care *" oe�a�na RM/ BRD - NURSING - SEMI-PVT 09/Ot-091 341.00 30.00 10,230.00 21,367.40 Paga 1 RESIDENTp CURRENT OVER30 OVERfiO OVER90 OVER120 TOTALAMOUNTDUE 81321 10,230.00 10,583.00 554.40 0.00 0.00 $21,367.40 RESioEN7 NnME THE ESTATE OP DORIS ROYER FamPBDi Please make check payable to Messiah Lifeways at Messiah Village. A 1%finance charge may be assessed on accounts for which payment has not been received by the tlue date. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. � MESSIAH � � �. � �% T�.�_1: C% I� � Fnm PBL1 L ewa s� W � at MESSIAH VILLAGE 100 MT.ALLEN DR.,MECHANICSBURG,PA 1➢055 RESIDENT# UNIT STMT. DATE 81321 255 D 08/3112013 RESIDENT S PAUL HOFFMAN THE ESTATE OF DORIS ROYER 6349 BENNINGTON ROAD MECMANICSBURG, PA 17050 TOTALAMOUNTDUE $17732.00 DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE $ _ _,__ ,.._____ AMOUNTREMITTED OATE DESCRIPTION RATE Dapl CNARGES CREDITS BALANCE Units Balance Forv✓ard 21,367.40 �onena PpYMENTRECEIVED - THANKYOU 11,137.40 10,230.00 "' Nursing Care *"' �o�o�na RM/ BRD - NURSING - SEMI-PVT 10101-101 341.00 22.00 7,502.00 17,732.00 Gage 1 , RESIOENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTALAMOUNT DUE 81321 7,502.00 10,230.00 0.00 0.00 0.00 317,732.00 RESiDENT NaME THE ESTATE OF DORIS ROYER FamGeC P�ease make check payahle to Messiah Lifeways at Messiah Village. A 1%tinance charge may be azsessed on accounts for which paymant has not bean receivetl 6y the due dale. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790•8220. COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DNISION ESTATE OF DORIS A. ROYER, DECEASED No. 2015-00026 CERTIFTCATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of Ihe foregoing Noticc of Claim was secved via Certified Mail, Retum Receipt Requested and FicshClass United States mail, postage pmpaid, upon the following: Craig A. Ha[ch, Esquire Halbruner, Hatch & Guise, LLP 2109 Ma�ket Street Camp Hill, PA L7011 -7 / ,/� — Dated: 5 - �� - �� ` Steven M. Montresor 534060v1